Medical Oncologist
Understanding your treatment
Enzalutamide and Steroids: — Why You Don't Need Prednisolone
If you have been prescribed enzalutamide and are wondering whether you also need prednisolone, the short answer is no. The reason comes down to how enzalutamide and abiraterone work differently — and why the steroid requirement belongs to one drug, not to prostate cancer treatment in general.
Medically reviewed by Dr. T. Raghavender Reddy, Medical Oncologist, MBBS · DM (Medical Oncology) · MD (Radiation Oncology) · Last reviewed August 2026
- No steroid required — Enzalutamide is taken without prednisolone or any other steroid as a routine co-medication.
- Different mechanism from abiraterone — Abiraterone blocks a hormone-making enzyme and needs a steroid to manage the consequences. Enzalutamide does not work on that enzyme at all.
- Switching needs care — If you are moving from abiraterone to enzalutamide, do not stop prednisolone suddenly — your team will give you a tapering schedule.
- Other steroids still matter — Any steroid you take for asthma, joint disease or a skin condition is still important to tell your team about.
17+
Cancer Specialists
on Panel
on Panel
96.9%
Breast Cancer
Survival Rate*
Survival Rate*
15,000+
Patients
Treated
Treated
4.8★
Google Rating
(800+ reviews)
(800+ reviews)
Enzalutamide does not require a steroid. It blocks the androgen receptor — the switch testosterone uses to activate cancer cells — rather than the enzyme that makes testosterone. Abiraterone targets that enzyme, which is why a steroid is needed alongside it. Enzalutamide does not create that need.
Why does abiraterone need a steroid but enzalutamide does not?
Abiraterone blocks an enzyme called CYP17A1, which the body uses to make both testosterone and cortisol. When cortisol production falls, the pituitary gland responds by releasing more of a signal hormone called ACTH, trying to restart it.
That ACTH surge drives a build-up of other hormones upstream of the blockade — hormones that raise blood pressure and lower potassium. A low dose of prednisolone, taken twice a day as specified in abiraterone's prescribing information approved by the FDA and the EMA, suppresses that ACTH surge and prevents those effects.
Enzalutamide works in a completely different place. It blocks the androgen receptor — the protein inside cancer cells that testosterone needs to bind to in order to drive growth. It does not touch the enzyme pathway at all, so the chain reaction that creates the need for a steroid never starts.
If you are switching from abiraterone to enzalutamide, what happens to the steroid?
If you have been taking prednisolone with abiraterone, your team will usually taper the dose down gradually rather than stopping it on the day you switch. Taking a corticosteroid for weeks or months reduces the adrenal glands' own output, and stopping abruptly can cause withdrawal.
Do not stop prednisolone on the day you start enzalutamide, even knowing that enzalutamide does not require one. Follow the schedule your oncologist gives you exactly.
Once off prednisolone, you take enzalutamide alone. For most people this is simpler — one drug, no companion steroid to remember twice a day.
Meet the Specialists
17+ senior cancer specialists. One panel for your case.
Trained at AIIMS, Tata Memorial, and leading international centres. Combined 150+ years of experience. Every complex case is reviewed by 3+ of them — together.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
Radiation Oncologist
Radiation Oncologist
Radiation Oncologist
Hematologist
Interventional Radiologist
Dr. Mohammed Imran
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
Surgical Oncologist
Want a specific doctor for your case? Mention them when booking.
Book Free ConsultationBook an appointment with our specialist
Share your name and number — we'll call you back within 30 minutes to schedule your consultation.
You do not have to work this out alone
A 45-minute consultation with a specialist who treats this every week.
What do these hormone terms mean?
- Androgen receptor
- A protein inside prostate cancer cells that testosterone binds to, switching on growth signals. Enzalutamide blocks this receptor, which is how it works against the cancer.
- CYP17A1
- An enzyme the body uses to make testosterone and cortisol. Abiraterone inhibits this enzyme — that action sets off the chain reaction that makes a steroid necessary.
- Mineralocorticoid
- Hormones that control salt and fluid balance. When abiraterone blocks CYP17A1, mineralocorticoids build up and cause fluid retention and raised blood pressure — effects that prednisolone is prescribed to prevent.
- ACTH
- A hormone released by the pituitary gland when cortisol is low. The ACTH surge triggered by abiraterone is what prednisolone suppresses. Enzalutamide does not trigger this surge.
- Prednisolone / prednisone
- Low-dose corticosteroids prescribed alongside abiraterone to manage the consequences of enzyme blockade. They are not part of the enzalutamide regimen.
What should you tell your team before starting enzalutamide?
- Every steroid you are currently taking — tablets, inhalers, nasal sprays, or skin creams
- Whether you are still tapering off prednisolone from a previous treatment
- Any history of adrenal gland problems or adrenal insufficiency
- All supplements and herbal remedies, as several affect how enzalutamide is broken down by the liver
- Any blood pressure medication, since your blood pressure profile may change once abiraterone and its steroid are stopped
Did you know?
The prescribing information for abiraterone, as approved by the US FDA and the European Medicines Agency, lists low-dose prednisolone as a required co-medication — not optional. The prescribing information for enzalutamide contains no such requirement.
The steroid requirement comes from how abiraterone works, not from having prostate cancer. It travels with the drug, not with the diagnosis.
Source: FDA and EMA prescribing information for abiraterone acetate and enzalutamide
Explore 50 more Prostate Cancer Targeted Medicines topics
Drug Deep Dive: Enzalutamide (Xtandi)
- Diet and Nutrition While on Enzalutamide
- Dizziness, Falls and Seizure Risk on Enzalutamide
- Does Enzalutamide Need a Steroid? Why It Differs From Abiraterone
- Enzalutamide (Xtandi, Bdenza, Enzamide): The Complete Patient Guide
- Enzalutamide Interactions: Blood Thinners, Statins and Seizure-Threshold Drugs
- Enzalutamide Myths: 'It's Chemotherapy', Fatigue and Loss of Masculinity
- Enzalutamide Price in India: Brand, Generic and Monthly Cost
- Enzalutamide Side Effects: The Complete List and Timeline
- Enzalutamide Success Rate and Survival: An Honest Look at the Numbers
- Enzalutamide With ADT and Other Prostate Cancer Treatments
- Enzalutamide in Elderly Patients and Those With Other Illnesses
- Enzalutamide in Non-Metastatic vs Metastatic Prostate Cancer
- Enzalutamide vs Abiraterone vs Apalutamide: Choosing an AR Inhibitor
- Fertility, Pregnancy and Contraception on Enzalutamide
- How Does Enzalutamide Work? The Androgen Receptor Signalling Inhibitor Explained
- How Long Does Enzalutamide Take to Work?
- How Long Will You Stay on Enzalutamide?
- Memory, Concentration and Blood Pressure Changes on Enzalutamide
- Severe Fatigue on Enzalutamide: The Commonest Reason Men Stop
- Taking Enzalutamide: Food, Timing and What to Do If You Miss a Dose
- Tests and Monitoring While You Are on Enzalutamide
- When Enzalutamide Stops Working: Resistance and What Comes Next
- Who Is Eligible for Enzalutamide? Advanced and Metastatic Prostate Cancer
- Will Insurance or a Government Scheme Pay for Enzalutamide?
- Work, Travel and Daily Life on Enzalutamide
Drug Deep Dive: Abiraterone (Zytiga)
- Abiraterone (Zytiga, Abirapro, Abretone): The Complete Patient Guide
- Abiraterone Interactions: Steroids, BP Medicines and Herbal Products
- Abiraterone Myths: Steroids, Weight Gain and 'It Stops Working Fast'
- Abiraterone Price in India: Brand, Generic and Monthly Cost
- Abiraterone Side Effects: The Complete List and Timeline
- Abiraterone Success Rate and Survival: An Honest Look at the Numbers
- Abiraterone With ADT, Docetaxel and Radiation: Your Full Regimen Explained
- Abiraterone in Elderly Patients and Those With Other Illnesses
- Abiraterone in Hormone-Sensitive vs Castration-Resistant Prostate Cancer
- Abiraterone vs Enzalutamide: How to Choose in Prostate Cancer
- Diet and Nutrition While on Abiraterone
- Fatigue, Hot Flushes and Joint Pain on Abiraterone
- Fertility, Pregnancy and Contraception on Abiraterone
- How Does Abiraterone Work? The CYP17 Inhibitor Explained
- How Long Does Abiraterone Take to Work?
- How Long Will You Stay on Abiraterone?
- Liver Enzyme Rises on Abiraterone: Why the First Three Months Matter Most
- Swelling, Low Potassium and High Blood Pressure on Abiraterone
- Tests and Monitoring While You Are on Abiraterone
- When Abiraterone Stops Working: Resistance and What Comes Next
- Who Is Eligible for Abiraterone? Advanced and Metastatic Prostate Cancer
- Why Abiraterone Is Always Given With Prednisolone
- Why Abiraterone Must Be Taken on an Empty Stomach
- Will Insurance or a Government Scheme Pay for Abiraterone?
- Work, Travel and Daily Life on Abiraterone
Next step
Still not sure what applies to you?
Send your reports across and a senior medical oncologist will go through what they mean, what is known, and what the options actually are.
Common questions
Frequently asked questions
Can I take prednisolone alongside enzalutamide if I feel I benefit from it?
Not without your oncologist knowing. Steroids are not neutral — they suppress the immune system, affect blood sugar, bone density and mood, and interact with other medications. If you feel there is a reason prednisolone helps you, that is a conversation to have with your team. They may find a cause that can be addressed directly rather than managed with a steroid your cancer treatment does not require.
Will stopping prednisolone make enzalutamide less effective?
No. Prednisolone is not part of how enzalutamide works. It plays no role in blocking the androgen receptor and does not affect the drug's activity against cancer cells. The reason to taper carefully when switching from abiraterone is about your adrenal glands adjusting to producing their own cortisol again — not about protecting enzalutamide's effectiveness.
Does enzalutamide cause any side effects that would need a steroid to manage?
Not as a routine part of treatment. Enzalutamide has its own side effect profile — fatigue, hot flushes, and a small risk of seizures are listed in prescribing guidance from the FDA and EMA — but none of these are typically managed with a steroid. If you develop a specific problem during treatment where a steroid might help, your oncologist will decide that separately, on its own merits.
Is there any situation where a doctor would prescribe a steroid alongside enzalutamide?
Yes, but for reasons unrelated to how enzalutamide works. Some patients take steroids for other conditions such as asthma, joint disease, or an inflammatory reaction. Some clinical trial protocols include a steroid as part of a combination regimen. And some patients develop inflammatory reactions during treatment that may need short-term steroid management. None of these reflect a routine requirement of the kind that prednisolone is a required part of abiraterone.
My previous treatment included a steroid. How quickly can I come off it?
That depends on how long you were on prednisolone and at what dose, not on when you start enzalutamide. Tapering schedules are set by your oncologist based on your individual history. Do not try to time the taper to match your first enzalutamide dose — the two are separate decisions. Ask your team for a written schedule so you know exactly what to take each day during the transition.
If enzalutamide does not need a steroid, why do some people say all prostate cancer hormone drugs need one?
That belief comes from abiraterone, which was for a time the most widely used hormonal drug for advanced prostate cancer and which does require a steroid. Because many patients and families encountered abiraterone first, the association between hormone therapy and steroids stuck. Enzalutamide has a different mechanism and does not carry that requirement. If your prescription is for enzalutamide, you do not need prednisolone unless your team has prescribed it for a separate reason.